These cases
can also be accessed by clicking on the Case of the Week button on the
left hand side of our Home Page at www.PathologyOutlines.com. This
email is sent only to those who subscribe in writing or by email. To view the
images or references, you must click on the links in blue.

To
subscribe or unsubscribe, email info@PathologyOutlines.com,
indicating subscribe or unsubscribe to Case of the Week. We do not sell, share
or use your email address for any other purpose. We also maintain two other email
lists: to receive a biweekly update of new jobs added to our Jobs page, and to
receive a monthly update of changes made to the website. You must subscribe or
unsubscribe separately to these email lists.

We
thank Professor D. Y. Cohen, Department of Pathology, Herzliyah Medical Center, Israel, for contributing this case. We invite you to contribute a Case of the
Week by emailing NPernick@PathologyOutlines.comwith microscopic images (any size, we will shrink if necessary) in JPG or
GIF format, a short clinical history, your diagnosis and any other images (gross,
immunostains, EM, etc.) that you have and that may be helpful or interesting. We
will write the discussion (unless you want to), list you as the contributor,
and send you a check for $35 (US) for your time after we send out the case. Please
only send cases with a definitive diagnosis.

Case
of the Week #26

Clinical
History

A 29
year old man had a left testicular mass, which was excised.

Gross
description: Most of the testis was
replaced by a 5.9 cm gray-white mass with focal hemorrhage that was adjacent to
the tunica albuginea. There was only a small peripheral rim of normal
appearing testicular tissue. The spermatic cord was unremarkable.

Most
testicular tumors are mixed, and for prognostic purposes, it is important to
list the components present and to estimate their percentage involvement. Figure
1 and figure
2 illustrate the seminomatous component. Tumor cells are polyhedral,
with clear cytoplasm and central large nuclei, that upon higher magnification,
have prominent nucleoli. Seminoma cells are PAS positive and immunoreactive
for PLAP. The stroma contains a prominent lymphocytic infiltrate. Figure
3 and figure
4 demonstrate the yolk sac component, which is frequently missed by
pathologists who do not look for it specifically. Yolk sac tumors have
numerous patterns. The classic pattern has numerous Schiller-Duval bodies,
composed of a central capillary surrounded by visceral and parietal layers of
glomeruloid-type cells (image).
The alpha-fetoprotein immunostain (image) may
be helpful in identifying or confirming a yolk sac component, although
embryonal carcinomas, teratocarcinomas and other tumors may also be AFP
positive. Finally, this tumor had a prominent immature teratoma component (figure
5, figure
6, figure 7).
The tumor had neurectodermal structures with retinal-like elements, immature
cartilage and blastema-like elements resembling Wilm’s tumor. Immature
teratoma elements are often graded as high or low grade, although the
prognostic significance of this grading is not well established. High grade
tumors are highly cellular with mitotically active, immature elements.

The
list of required elements to report for testicular tumors, as well as current
staging systems, is available from the College of American Pathologist’s web
site (click here).